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Finite Element Modeling of Subcutaneous Implantable Defibrillator Electrodes in an Adult Torso

1Department of Anesthesia, Stanford University, Stanford, CA, USA.
2Scientific Computing Institute, University of Utah, Salt Lake City, UT, USA.
3Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
4Department of Cardiology, Stanford University, Stanford, CA, USA.
5Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
Elsevier Science
Publication Date:
Heart Rhythm
Volume Number:
Issue Number:
Heart Rhythm. 2010 May;7(5):692-8.
PubMed ID:
ICD, Defibrillation, Modeling
Appears in Collections:
P41 RR012557/RR/NCRR NIH HHS/United States
P41 RR013218/RR/NCRR NIH HHS/United States
P41 RR012553/RR/NCRR NIH HHS/United States
Generated Citation:
Jolley M., Stinstra J., Tate J., Pieper S., Macleod R., Chu L., Wang P., Triedman J.K. Finite Element Modeling of Subcutaneous Implantable Defibrillator Electrodes in an Adult Torso. Heart Rhythm. 2010 May;7(5):692-8. PMID: 20230927. PMCID: PMC3103844.
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Total subcutaneous implantable subcutaneous defibrillators are in development, but optimal electrode configurations are not known. OBJECTIVE: We used image-based finite element models (FEM) to predict the myocardial electric field generated during defibrillation shocks (pseudo-DFT) in a wide variety of reported and innovative subcutaneous electrode positions to determine factors affecting optimal lead positions for subcutaneous implantable cardioverter-defibrillators (S-ICD). METHODS: An image-based FEM of an adult man was used to predict pseudo-DFTs across a wide range of technically feasible S-ICD electrode placements. Generator location, lead location, length, geometry and orientation, and spatial relation of electrodes to ventricular mass were systematically varied. Best electrode configurations were determined, and spatial factors contributing to low pseudo-DFTs were identified using regression and general linear models. RESULTS: A total of 122 single-electrode/array configurations and 28 dual-electrode configurations were simulated. Pseudo-DFTs for single-electrode orientations ranged from 0.60 to 16.0 (mean 2.65±2.48) times that predicted for the base case, an anterior-posterior configuration recently tested clinically. A total of 32 of 150 tested configurations (21%) had pseudo-DFT ratios
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